Category: education

The Sexually Transmitted Infection Research Foundation (STIRF) is a local charity which supports research relating to all aspects of sexual health including clinical practice, public health, microbiology, health economics and behavioural science.

STIRF wishes to fund a PhD Studentship up to a maximum of £60 000 over 3-4 years and is inviting applications with a closing date of July 31, 2018.

Applications would only be considered from universities in the following UK health regions:

In the latest issue of the Sexually Transmitted Infections, Phillip Hay and colleagues in the UK report on a prospective study of female students attending 11 universities and 9 further education colleges in London.

At the start, the students were asked to fill a questionnaire and provide a self taken vaginal sample for infection screening. After 12 months, they were assessed for pelvic inflammatory disease (PID), a condition that can lead to infertility and other complications.

PID was found in 1.6% of the particpants. Unsurprisingly the strongest predictor of PID was the presence of Chlamydia trachomatis at the first visit (relative risk (RR) 5.7).

However, adjusting for this, the authors reported that significant predictors of PID were ≥2 sexual partners (RR 4.0) or a new sexual partner during follow-up (RR 2.8), and age <20 years (RR 3.3). Somewhat surprisingly recruitment from a further education college rather than a university also increased the relative risk of PID 2.6 fold, perhaps reflecting different health protection behaviors (eg condom use) between the two groups.

The study concluded that in addition to known risk factors such as multiple or new partners in the last 12 months and younger age, attending a further education college rather than a university were risk factors for PID.

They recommended that sexual health education and screening programs could be targeted at these high-risk groups.

Daily HIV medicine taken by men who have sex with men (MSM) reduces risk of HIV infection by 86% as was reported by Molina J-M, and colleagues in the ANRS Ipergay trial at the Conference on Retroviruses and Opportunistic Infections held in Seattle, USA in 2015 (23LB.).

Molina et al reported the final results of a three year study which randomised MSM who were negative for HIV to either take daily HIV prophylaxis with two anti-retroviral drugs in a single tablet immediately or deferred for 1 year.

The study showed that those taking the drugs on a daily basis have a 86% reduction in the risk of being infected by HIV than MSM not taking the drug (p=0.0001). The trial was stopped in October of 2014 and all participants in the deferred group were offered pre-exposure prophylaxis (PrEP)

The science is now clear: oral pre-exposure prophylaxis (PrEP) with a coformulation of tenofovir disoproxil fumarate and emtricitabine (Truvada) significantly reduces the risk of HIV infection among individuals at high risk of HIV infection.

The news that PrEP has shown consistent efficacy among those who take it as prescribed should be a cause for celebration, and galvanise action to ensure access to PrEP for those who could benefit the most. But almost 3 years since the US Food and Drug Administration approved tenofovir–emtricitabine for PrEP little is being done on implementation.

Background: In the United Kingdom there is an established and growing refugee population from Somalia. Despite this Somalis have remained absent from much of the official statistics largely because ‘Somali’ is rarely recognised as a distinct ethnic category. Little is known about the sexual health needs of this particular community but in terms of their broader health issues, Somalis are known to have a high level of need but low uptake of health care services (Carswell et al.2011).

Aims: Through the use of focus groups and individual interviews this study sought to explore the sexual health needs of the local Somali community by ascertaining from their perspective, what they know about sexual health services, the challenges that may prevent them taking up these services and how services could be adapted to best meet their needs.

Results: The study showed little knowledge of services, especially about sexual health, how to accessing services, issues relating to shame, stigma and taboo, the influence of gender, religious and cultural norms, the perceptions of young people, the language barrier lack of cultural awareness and sensitivity demonstrated by healthcare professionals.

Recommendations:

Urgent attention be given to raising awareness, amongst the Somali community, about local sexual health services and how they can be accessed.

Information about sexual health services be made available in a format that is accessible to the Somali refugee community, for example, via a CD, DVD or USB stick.

That public health professionals and health care practitioners make clear the concept of preventative screening, making explicit the value of screening and early diagnosis for infectious diseases including TB and HIV/AIDS.

Health practitioners and public health professionals exercise extreme sensitivity when discussing issues related to sexual health and well-being. Every effort must be made to gain the trust of the individual so that they are able to discuss their fears or concerns.

Public health professionals and health care practitioners receive appropriate training and education so that they are equipped with the necessary cultural understanding and skills when working with the Somali community.

That a proactive approach be taken to helping Somali refugees to attend a programme of induction that includes language classes.

That a register of trained interpreters, who understand medical terminology and who are trained to work with those who may have experienced rape and torture should be available for public health professionals and health practitioners. Telephone interpretation should also be made available during consultations.

The results of the study have been presented in international meetings and published in reputable international journals.

The US based Centre for disease control (CDC) has recently updated its factsheet on lesbian and bisexual health. The CDC emphasises the potential risks of acquiring sexually transmitted infections and HIV from certain sexual practices. The article provides advise on how lesbian and bisexual women can protect themselves.

The National Survey of Sexual Attitudes and Lifestyles (NATSAL) is a survey of men and women carried out in the Britain every 10 years. It remains the most extensive and accurate study of sexual behaviour in a carefully selected population of men and women in the UK that reflect the population of sexually active individuals.

Natsal-3 is a sample survey of 15,162 men and women (6,293 men) aged 16–74 years, resident in Britain, undertaken between September 2010 and August 2012. Participants were interviewed using a combination of face-to-face, computer-assisted, personal interviewing (CAPI) and computer-assisted self-interviewing (CASI). The more sensitive questions, including those on paying for sex and sex while outside the UK, were asked in the CASI.

Their results show that round one in 10 men in Britain report having ever paid for sex at some time. These men are more sexually active than men who do not report having had paid for sex. They have a higher number of sexual partners, only a minority (18.4%) of which are paid.

They are also more likely to report a diagnoses of a sexually transmitted infection (STI) even when accounting for their disproportionately larger number of sexual partners (which is considered the most important behavioural variable associated with STI diagnoses).

This evidence strongly supports the idea that this subgroup of men are a bridge for the sort of sexual mixing (dissociative mixing) that increases the spread of STIs.

Men who pay for sex (MPS) are most likely to be aged between 25 and 34 years, single, in managerial or professional occupations, and have high partner numbers.

After adjusting for the key risk behaviour of sexual partner numbers, these men still report many other sexual behaviours, such as having new foreign partners while outside the UK, less attendance at STI clinic and less condom use. They therefore show an increased vulnerability to STI without taking the necessary precautions.

Interestingly, for some reported behaviours, such as sex partners outside the UK, same sex contact, sex partners found online, and concurrent partners (more than one partner at any time), total and paid partner numbers increase.

This suggests that MPS exhibiting these behaviours have higher lifetime partner numbers than other MPS as well as higher paid partner numbers, putting them at a higher risk for STIs than other MPS.

On May 8 2014 the UK Court of Appeal dismissed the appeal of David Golding against a 14 month prison sentence for transmitting herpes to his partner.

An Editorial in the BMJ by Emily Clarke an colleagues highlights the numerous and complicated issues that arise from this verdict including:

what constitutes grievous bodily harm,

how you determine that sexual transmission has occurred,

how serious is herpes infection, and

what this judgement means both for health care workers who advise and inform patients on the risks of transmission and on the infected individual and their duty of informing all partners of potential risk of transmitting an infection even during asymptomatic shedding.

The Editorial correctly highlights the dangers of criminalizing sexually transmitted infections and the various problems that arise from this judgement which was based on a law passed 170 years ago addressing totally unrelated issues and at a time when STI’s were not understood as they are today.

The debate about whether to circumcise or not continues to raise passions. The fact that male circumcision reduces acquisition of HIV from an infected partner has been proven by three randomised clinical trials. And male circumcision may also protect against other sexually transmitted infections.

Just as the vaginal microbiome differs among women and changes over time, the penis is home to a variety of bacteria that vary with age, sexual activities, and whether the man is circumcised, among other things. And it’s not just the skin that envelops the male sexual organ that’s inhabited by microbes: researchers continue to identify bacteria that dwell within the urogenital tract, a site once considered sterile in the absence of infection.

David Nelson and colleagues at Indiana University in Bloomington found evidence to suggest that the sexually transmitted pathogens in the urogenital tract were obtaining metabolites from other microbes. “There was a signature in the chlamydial genome that suggested this organism might be interacting with other microorganisms,” said Nelson. “That’s what initially piqued our interest. And when we went in and started to look, we found that there were a lot more [microbes] than we would have anticipated being there.”

The researchers found that some men pass urine containing a variety of lactobacilli and streptococci species, whereas others have more anaerobes, like Prevotella and Fusobacterium. In terms of overall composition, “we see a lot of parallels to the gut,” said Nelson, noting that there doesn’t seem to be a standout formula for a “healthy” urogenital tract. Commensal microbes within the urethra could make a man more susceptible to infection by supporting colonization by pathogens like Chlamydia, whereas bacteria that consume the environment’s nutrients could help prevent it. “We just don’t know at this point,” said Nelson.

To date, circumcision is the known largest influence on the composition of the penis microbiome. In a 2010 PLOS ONE paper, Lance Price of the Translational Genomics Research Institute in Phoenix, Arizona, and his colleagues showed that the bacteria that colonized the base of the penis’s tip, or glans, varied before and after circumcision. More specifically, the researchers found fewer anaerobic bacteria within six months after the men in a study were circumcised. Those findings have since been confirmed.